CMS unveils additional Medicare RAC details

In hopes to regain more fraudulent claims, CMS reveals next step of the RAC program. Source: Piper Report

The Centers for Medicare & Medicaid Services (CMS) plans to select four independent contractors to run the new U.S. Medicare Recovery Audit Contractor (RAC) program in September, which will be phased in state-by-state.

For the new national RAC program, the four contractors will continue to send their requests for medical records via postal mail, said Melanie K. Combs-Dyer, a CMS senior technical advisor. Providers will be able to submit the records via postal mail, fax or mailed CD or DVD.

“CMS is exploring mechanisms that would allow providers to electronically upload imaged medical records to the RAC,” she added. “On or before January 2010, each RAC will develop and implement a web-based application that allows providers to see the status of each medical record request.”

In response to hospitals’ complaints during the RAC demonstration about being inundated by requests for records, CMS said it plans to establish a limit on the number of records that can be requested during each 45-day period. The limit will be posted on the agency’s website, along with the state-by-state phase-in schedule.

In the new national program, Medicare claims from physicians as well as hospitals will be subject to audits, and RACS may choose to review any claim that is likely to contain an improper payment, according to CMS.